Healthcare Experiences Of Patients Research Articles

Criterion-Based Measurements of Patient Experience in Health Care

Criterion-Based Measurements of Patient Experience in Health Care

Attitudes and Intentions of US Veterans Regarding COVID-19 Vaccination

Compared with the general population, veterans are at high risk for COVID-19 and have a complex relationship with the government. This potentially affects their attitudes toward receiving COVID-19 vaccines. To assess veterans' attitudes toward and intentions to receive COVID-19 vaccines. This cross-sectional web-based survey study used data from the Department of Veterans Affairs (VA) Survey of Healthcare Experiences of Patients' Veterans Insight Panel, fielded between March 12 and 28, 2021. Of 3420 veterans who were sent a link to complete a 58-item web-based survey, 1178 veterans (34%) completed the survey. Data were analyzed from April 1 to August 25, 2021. Veterans eligible for COVID-19 vaccines. The outcomes of interest were veterans' experiences with COVID-19, vaccination status and intention groups, reasons for receiving or not receiving a vaccine, self-reported health status, and trusted and preferred sources of information about COVID-19 vaccines. Reasons for not getting vaccinated were classified into categories of vaccine deliberation, dissent, distrust, indifference, skepticism, and policy and processes. Among 1178 respondents, 974 (83%) were men, 130 (11%) were women, and 141 (12%) were transgender or nonbinary; 58 respondents (5%) were Black, 54 veterans (5%) were Hispanic or Latino, and 987 veterans (84%) were non-Hispanic White. The mean (SD) age of respondents was 66.7 (10.1) years. A total of 817 respondents (71%) self-reported being vaccinated against COVID-19. Of 339 respondents (29%) who were not vaccinated, those unsure of getting vaccinated were more likely to report fair or poor overall health (32 respondents [43%]) and mental health (33 respondents [44%]) than other nonvaccinated groups (overall health: range, 20%-32%; mental health: range, 18%-40%). Top reasons for not being vaccinated were skepticism (120 respondents [36%] were concerned about side effects; 65 respondents [20%] preferred using few medications; 63 respondents [19%] preferred gaining natural immunity), deliberation (74 respondents [22%] preferred to wait because vaccine is new), and distrust (61 respondents [18%] did not trust the health care system). Among respondents who were vaccinated, preventing oneself from getting sick (462 respondents [57%]) and contributing to the end of the COVID-19 pandemic (453 respondents [56%]) were top reasons for getting vaccinated. All veterans reported the VA as 1 of their top trusted sources of information. The proportion of respondents trusting their VA health care practitioner as a source of vaccine information was higher among those unsure about vaccination compared with those who indicated they would definitely not or probably not get vaccinated (18 respondents [26%] vs 15 respondents [15%]). There were no significant associations between vaccine intention groups and age (χ24 = 5.90; P = .21) or gender (χ22 = 3.99; P = .14). These findings provide information needed to develop trusted messages used in conversations between VA health care practitioners and veterans addressing specific vaccine hesitancy reasons, as well as those in worse health. Conversations need to emphasize societal reasons for getting vaccinated and benefits to one's own health.

7.N. Workshop: Engaging the young stakeholders in planning for recovery from the Covid-19 pandemic

Health in children and young people (CYP) has been impacted by the COVID-19 pandemic. Restrictions in mobility and social contacts limited children and young people in their social development and led to adverse psychological impact. Rising rates of poverty because of lockdowns have been shown to particularly impact families with children, which may exacerbate already existing health inequalities. Containment policies have decreased access to health services and decreased support for CYP from health and social care professionals during the pandemic, which have posed a significant threat to children and young people's physical health, mental and emotional health. To ensure that policies aimed at mitigating the impact of the pandemic on CYP are relevant, it is vital that the voices of CYP are heard. Article 12 of UNCRC establishes the right of a child to express their views in all matters affecting them and for those to be given appropriate consideration. This is a right that is largely not upheld in policymaking, and therefore it is important that the public health sector as advocates for children and young people (CYP) lead on this.The aims of this skill building workshop are to: Showcase positive examples of engagement of CYP in policymakingGain knowledge on the practicalities to make engagement with CYP a mutually beneficial experience Workshop Format The session will be chaired by a young person to role-model the inclusion of CYP, this workshop advocates for.Professor Sonia Saxena, President of the EUPHA section on Child and Adolescent Public Health, will open the session with key points on the importance of engaging CYP in policy making during the COVID-19 pandemic and beyond.A further two presentations will be delivered by young people who will reflect on their own experience of engagement with policy/research and utilise the lessons learnt to improve CYP engagement in the future.This will be followed by a presentation by a paediatric doctor reflecting on their role in engaging with children and young people to develop a national healthcare patient experience guideline.This series of short presentations will be followed by an interactive case scenario on CYP engagement during the C-19 pandemic. The case study will aim to discuss some of the key practicalities to consider when engaging children and young people in policy making.The session will close with a short panel discussion with the presenters and consensus vote by attendees of next steps to take the learning from the workshop forward. Workshop proceedings will be written up and submitted for publication in a peer-reviewed journal. Twitter hashtags will be devised to allow attendees to share work they embark upon within an online community. This community will also be fostered through meetings supported by EUPHA where members can share best practice and solutions to problems encountered.Speakers/Panelists Sonia Saxena Imperial College London, London, UK Rakhee Shah Imperial College, London, UK Gabrielle Mathews Imperial College London, London, UK Bea Albermann University of Zurich, Zurich, Switzerland Jinane Ghattas UCLouvain, Saint-Josse-ten-Noode, Belgium Key messages COVID19 will have a large impact on children and young people’s health.Engaging children and young people to co-produce policies that affect them, when planning for recovery from the pandemic is crucial in ensuring our policies and research are most impactful.

Receiving healthcare for drug-resistant TB: a cross-sectional survey from Pakistan.

To describe and quantify patients' self-reported experiences of receiving healthcare from Pakistan's Programmatic Management of Drug-Resistant Tuberculosis (PMDT) model of care, and to understand these experiences within the broader context of Pakistan's health system. This was a cross-sectional survey of patients attending three PMDT clinics in Khyber-Pakhtunkhwa Province in Pakistan. The median consultation time at the PMDT clinics was 10 minutes. In their most recent visit to the PMDT clinic, 34.9% of patients spent >40% of their monthly income to access treatment. To specify, 71% of patients reported spending out-of-pocket for ancillary medicines and 44.7% for laboratory tests. In 10.5% of cases, medicines for drug-resistant TB (DR-TB) were dispensed without the patient attending the clinic. Only 43.7% of treatment supporters regularly accompanied patients to the clinic, and 6% supervised the patient's intake of medicines. Disbursement of financial support was irregular in 98.6% of cases. Only 6.2% of patients received their daily injections from a public facility, the rest went elsewhere. Several shortcomings in PMDT services, including hurried consultations, irregularities in financial support, and gaps in Pakistan's broader health system undermined healthcare experience of patients with DR-TB. To improve health outcomes and patients' care experience these service gaps need to be addressed.

Veteran Experiences with Telehealth

Research ObjectiveIn FY18‐19, VA Office of Rural Health initiated a pilot program to increase access to services in underserved areas by funding 13 telehealth hubs. Understanding Veterans' experiences with telehealth hubs is essential to its delivery, especially in its scale‐up nationally and in response to the pandemic in FY20. We examine characteristics and ratings of care among Veterans with telehealth hub visits compared to usual primary care (PC) during the pilot program.Our objectives are to: Understand Veteran experiences with access, care coordination, comprehensiveness and primary care provider (PCP) communication during a telehealth pilot program. Examine Veteran characteristics associated with telehealth hub visits during a pilot program. Study DesignRegression analysis of a cross‐sectional data: VA Survey of Healthcare Experiences of Patients – Patient‐Centered Medical Home (SHEP‐PCMH), which uses Consumer Assessment of Healthcare Providers and Systems (CAHPS) questionnaires to survey Veterans on their healthcare experiences. We derived dichotomous outcomes from SHEP‐PCMH composite indices, indicating optimal experiences with access, care coordination, PCP communication, comprehensiveness (based on the percentages of responses that fall in the top category (Always or Yes) and PCP rating (9 or 10 out of 10). Key predictors were telehealth hub v. usual care index visit and proportion of telehealth hub visits in 6 months prior to the index visit. Other covariates included age, gender, race/ethnicity, education, number of PC visits in past year, self‐rated overall and mental health, and year of visit. We conducted multivariate logistic regression analyses to predict optimal care experiences, controlling for demographics, healthcare use, health status and year.Population StudiedVeterans receiving care at VA PC clinics offering telehealth hub visits during FY2018‐2019.Principal FindingsIn FY2018‐2019, 3201 out of 57,793 Veterans had a telehealth hub index visit. Telehealth hub utilization 6 months prior to index visit: 0.25% usual care v. 83% telehealth. Compared to usual care, the telehealth hub group was significantly older (age ≥ 65: 60% telehealth, 50.5% usual care), had fewer PC visits (0–1 visits: 69% telehealth, 56% usual care). In multivariate models, we failed to detect statistically significant difference between telehealth hub and usual care groups for the composite measures of Veteran experiences. Adjusted Odds Ratio (AOR) (95% CI): 0.68 (0.12–3.81), 0.3 (0.07–1.35), 1.55 (0.48–4.95), 0.47 (0.18–1.22), and 0.66 (0.18–2.49) for access, coordination, PCP communication, comprehensiveness, and PCP rating, respectively. Older age and greater number of PC visits were associated with greater likelihood of optimal care ratings; fair/poor overall and mental health were associated with lower likelihood of optimal experiences.ConclusionsCompared to usual care, telehealth hub users did not differ in likelihood ratings of optimal care experience although they are distinct in their demographics and healthcare utilization. Further study is needed, since the population of telehealth hub users is quite different from usual care population during pilot program.Implications for Policy or PracticeTelehealth hub visits were not associated with decrements in care experience. Our findings suggest that Veterans' experiences with tele‐health during the COVID‐19 pandemic might be similar to usual care. This is of importance since the Covid‐19 pandemic necessitates expanded use of virtual care to ensure patient safety.Primary Funding SourceDepartment of Veterans Affairs.

Health Care Experiences of Patients with Nonbinary Gender Identities.

The primary purpose of this study was to characterize the health care experiences of diverse patients with nonbinary gender identities across a range of geographic locations. A secondary aim was to use the qualitative findings to inform recommendations for clinics and providers to create gender-affirming health care environments for nonbinary patients. We conducted 3 focus group discussions with 7-9 participants, for a total of 24 unique participants. To be eligible, participants were required to be 18 years of age or older, live in the United States, speak English, have the ability to access Zoom in a private room, have a nonbinary gender identity, and be able to attend one of three scheduled focus groups. Participants reported frequent negative health care experiences, including misgendering, invalidation, and pathologization, even within clinics that signaled alliance with transgender communities. Participants described strategies they use to cope with negative experiences, including health care avoidance, identity concealment, and seeking out providers that are matched in terms of gender minority status and/or race. Recommendations for the provision of gender-affirming health care for nonbinary patients include nonbinary-inclusive intake forms and electronic health records, having providers be proactive in eliciting preferred names and pronouns, and requiring education for providers and staff at all levels on the provision of nonbinary-inclusive gender-affirming health care.

Inequalities in Health Care Experience of Patients with Chronic Conditions: Results from a Population-Based Study.

Patients’ experience is an acknowledged key factor for the improvement of healthcare delivery quality. This study aims to explore the differences in healthcare experience among patients with chronic conditions according to individual sociodemographic and health-related variables. A population-based and cross-sectional study was conducted. The sample consisted of 3981 respondents of the Basque Health Survey (out of 8036 total respondents to the individual questionnaire), living in the Basque Country, aged 15 or older, self-reporting at least one chronic condition. Patient experience was assessed with the Instrument for Evaluation of the Experience of Chronic Patients questionnaire, which encompasses three major factors: interactions between patients and professionals oriented to improve outcomes (productive interactions); new ways of patient interaction with the health care system (the new relational model); and the ability of individuals to manage their care and improve their wellbeing based on professional-mediated interventions (self-management). We conducted descriptive and regression analyses. We estimated linear regression models with robust variances that allow testing for differences in experience according to sociodemographic characteristics, the number of comorbidities and the condition (for all chronic or for chronic patients’ subgroups). Although no unique inequality patterns by these characteristics can be inferred, females reported worse global results than males and older age was related to poorer experience with the new relational model in health care. Individuals with lower education levels tend to report lower experiences. There is not a clear pattern observed for the type of occupation. Multimorbidity and several specific chronic conditions were associated (positive or negatively) with patients’ experience. Health care experience was better in patients with greater quality of life. Understanding the relations among the patients’ experience and their sociodemographic and health-related characteristics is an essential issue for health care systems to improve quality of assistance.

Quality of life in breast cancer patients with cancer treatment-related cardiac dysfunction: a qualitative study.

Although improved breast cancer (BC) treatment has decreased mortality, these anti-cancer regimens may have serious cardiovascular side effects that affect patients' long-term prognosis and quality of life (QoL). BC patients with cancer treatment-related cardiac dysfunction (CTRCD) can suffer from a variety of symptoms, such as dyspnoea and fatigue. The impact of CTRCD after BC treatment on patients' daily life has not been qualitatively explored yet. This study aims to explore the influence of CTRCD on QoL of women with BC, as defined by the concept of positive health. Second, we aim to evaluate the personal experience with cardiac surveillance during the BC trajectory. A qualitative study with semi-structured interviews was conducted and thematically analysed to explore the QoL and healthcare experiences of BC patients with CTRCD. Twelve patients participated in this study. Five themes are selected in response to the study objective: (i) patients: overwhelming fatigue, (ii) patients: mental burden of anxiety, (iii) social setting: lack of understanding and acceptance, (iv) medical specialists: lack of knowledge and acknowledgement, and (v) patients: need for personalized care. This study identified core components of the impact CTRCD has on the QoL of BC patients. Patients experienced an increased health-related burden due to CTRCD, affecting their physical, social, and psychosocial well-being. Healthcare experiences were largely affected by a lack of acknowledgement and professional communication. Patients underlined the need for personalized care during follow-up.

Methods for capturing patient experience and satisfaction in healthcare services.

Patient experience in healthcare has long been recognised in the UK and internationally as a crucial benchmark for assessing quality of care in healthcare settings. It is increasingly becoming part of a nurse's role to conduct, analyse and present the findings of patient satisfaction audits and research projects, and to implement changes to services based on the data collected. To undertake these audits and projects effectively, nurses require knowledge of how to use various data collection methods and research tools, determine their validity and reliability, and minimise bias. This article provides information about these areas, with the aim of assisting nurses in designing and implementing patient satisfaction audits and research projects in their clinical area, which can subsequently be used to improve patient experience.

Impact of Advanced Diabetes Centers on the healthcare experience of patients with type 2 diabetes using the IEXPAC tool

AimsTo determine the experience with healthcare among patients with type 2 diabetes according to the assistance model provided in their primary care centers, and to determine factors related with their experience. MethodsThis was a cross-sectional study performed in patients with type 2 diabetes with cardiovascular or renal complications. The patients were divided in two groups according to whether they had been attended in Advanced Diabetes centers (ADC) or the traditional assistance centers. Patient’s healthcare experience was assessed with the “Instrument for Evaluation of the Experience of Chronic Patients” (IEXPAC) questionnaire, with possible scores ranging from 0 (worst experience) to 10 (best experience). ResultsA total of 451 patients (215 from ADC and 236 from traditional assistance centers) were included. The mean overall IEXPAC scores were 5.9 ± 1.7 (ADC) and 6.0 ± 1.9 (traditional assistance centers; p = 0.82). In the multivariant analyses, in ADC, the regular follow-up by the same physician (p = 0.01) and follow-up by a nurse (p = 0.01), were associated with a better patient experience, whereas receiving a higher number of medications with a worse patient experience (p = 0.04). In the traditional assistance centers, only the regular follow-up by the same physician was associated with a better experience (p = 0.02). Patients from ADC centers reported a higher score in the quality of life scale (69.1 ± 16.5 vs 64.6 ± 17.5; p = 0.008). ConclusionsIn general, the healthcare experience of type 2 diabetic patients with their sanitary assistance can be improved. Patients from ADC centers report a higher score in the quality of life scale.

Rural Veterans' Experiences With Outpatient Care in the Veterans Health Administration Versus Community Care.

The 2014 Veterans Access, Choice and Accountability Act was intended to improve Veterans' access to timely health care by expanding their options to receive community care (CC) paid for by the Veterans Health Administration (VA). Although CC could particularly benefit rural Veterans, we know little about rural Veterans' experiences with CC. The objective of this study was to compare rural Veterans' experiences with CC and VA outpatient health care services to those of urban Veterans and examine changes over time. Retrospective, cross-sectional study using data from the Survey of Healthcare Experiences of Patients (SHEP) and VA Corporate Data Warehouse. Subjects: All Veterans who responded to the SHEP survey in Fiscal Year (FY) 16 or FY19. Outcomes were 4 measures of care experience (Access, Communication, Coordination, and Provider Rating). Independent variables included care setting (CC/VA), rural/urban status, and demographic and clinical characteristics. Compared with urban Veterans, rural Veterans rated CC the same (for specialty care) or better (for primary care). Rural Veterans reported worse experiences in CC versus VA, except for specialty care Access. Rural Veterans' care experiences improved between FY16 and FY19 in both CC and VA, with greater improvements in CC. Rural Veterans' reported comparable or better experiences in CC compared with urban Veterans, but rural Veterans' CC experiences still lagged behind their experiences in VA for primary care. As growing numbers of Veterans use CC, VA should ensure that rural and urban Veterans' experiences with CC are at least comparable to their experiences with VA care.

Factors Influencing Healthcare Experience of Patients with Self-Declared Diabetes: A Cross-Sectional Population-Based Study in the Basque Country.

Background: Diabetes affects more than 400 million people around the world. Few published studies incorporate questionnaires that comprehensively cover every aspect of a patient’s experience of healthcare. This study analyzes potential differences in the healthcare experience for patients with diabetes based on their sociodemographic, economic, and health-related characteristics from a comprehensive viewpoint in an integrated delivery system. Methods: We used data from the 2018 Basque Health Survey, which includes a questionnaire for the measurement of the experiences of patients with chronic problems. We present descriptive and regression analyses to explore differences by sociodemographic, economic, and health-related characteristics of patients’ experiences with different healthcare services. Results: Having diabetes plus other comorbidities significantly decreases the quality of the experience with all healthcare services and decreases the global healthcare experience score. When comorbidities are present, the elderly seem to report better experiences than younger patients. Some differences in experience can be explained by sociodemographic and economic factors. No differences exist between conditions co-occurring with diabetes. Conclusion: Patients with diabetes who also suffer from other conditions report worse experiences than individuals who suffer from diabetes only. No specific conditions explain the differences in care experience.

Reexamining “Defining Patient Experience”: The human experience in healthcare

In 2014, the authors came together with the explicit purpose of understanding how people were defining patient experience.1 Our broad review and analysis of the literature led us to a few critical points. One, as our review showed, there was an absence of a commonly used definition around patient experience in healthcare. Two, while consistency in the use of one definition was not revealed, there was great alignment around central components seen as critical to patient experience. Three, we highlighted the recurrence of key concepts from the literature that are also found in the definition offered by The Beryl Institute that include: ‘sum of all interactions,’ ‘the influence of organizational culture,’ ‘patient perceptions,’ and the importance of considering experiences ‘across the continuum of care.’ While this initial inquiry took place seven years ago, we would suggest that these core definitional concepts are no less relevant today and, in fact, may have grown in significance, as those in healthcare have come to better understand the scope and scale of experience. Hence, the purpose of this paper is to assess how the definition has evolved to encompass novel and timely viewpoints that complement the original definition and understand how - and in what ways - the definition has advanced. The definition of patient experience was a significant milestone. It provided simple language for the truly complex nature of what patient experience is and has ultimately served as a foundation for framing the human experience in healthcare. The human experience in healthcare integrates the sum of all interactions, every encounter among patients, families and care partners and the healthcare workforce. It is driven by the culture of healthcare organizations and systems that work tirelessly to support a healthcare ecosystem that operates within the breadth of the care continuum into the communities they serve and the ever-changing environmental landscapes in which they are situated. The human experience in healthcare ultimately is the fruit born from the core of patient experience itself. Experience Framework This article is associated with the Culture & Leadership lens of The Beryl Institute Experience Framework (https://www.theberylinstitute.org/ExperienceFramework). Access other PXJ articles related to this lens. Access other resources related to this lens

Remote primary care consultations for people living with dementia during the COVID-19 pandemic: experiences of people living with dementia and their carers.

BackgroundCOVID-19 has accelerated remote healthcare provision in primary care, with changes potentially permanent. The implementation of remote provision of health care needs to be informed by vulnerable populations, such as people living with dementia.AimTo understand the remote healthcare experiences of patients living with dementia and their family carers during the COVID-19 pandemic.Design and settingQualitative interviews with community-based patients living with dementia and their carers were carried out between May–August 2020, while the COVID-19 pandemic was ongoing in England.MethodSemi-structured interviews were conducted remotely by telephone or video call with 30 patients living with dementia and 31 carers. Data were analysed using thematic analysis.ResultsThree main themes were derived relating to: proactive care at the onset of COVID-19 restrictions; avoidance of healthcare settings and services; and difficulties with remote healthcare encounters. People living with dementia and their carers felt check-up calls were reassuring but limited in scope and content. Some avoided healthcare services, wishing to minimise COVID-19 risk or reduce NHS burden, or encountering technological barriers. Difficulties in remote consultations included lack of prompts to remember problems, dealing with new emerging difficulties, rescheduling/missed calls, and inclusion of the voice of the person with dementia.ConclusionWhile remote consultations could be effective, proactive calls could be more structured around needs. Consideration should be given to replace non-verbal prompts to describe problems, particularly for new health concerns. In continuing remote consultations, it is important to facilitate engagement with patients living with dementia and their carers to ensure good practice.

Patient healthcare experiences in the Northwest Territories, Canada: an analysis of news media articles

ABSTRACT The factors that influence patient healthcare experiences are complex and connected to place. In northern Canada, the socio-historical context and the inequitable distribution of health services are unique influences on patients. The objective of this study was to examine the characteristics of patient healthcare experiences as reported through news media in the Northwest Territories. We used a case series design to examine patient healthcare experiences reported in news media articles. We conducted a systematic search for articles published between 2008 and 2017 in the online database of a media outlet in the Northwest Territories. We used descriptive statistics to summarise the article characteristics and thematic analysis to understand patient experiences in 128 articles related to 71 cases. Most often, cases involved women, concerned mental health, suicidality, or chronic diseases, and were predominantly negative. Patient experiences included problems associated with medical travel, communication difficulties with providers, lack of cultural safety, and barriers in accessing care resulting in poor-quality care, particularly for Indigenous patients. Broadly, these experiences are rooted in the colonial history in the North. Understanding patient experiences and including Indigenous patients in health system decision-making can help focus policies and clinical care on cultural safety and equity.

Child Life Services.

Child life programs are an important component of pediatric hospital-based care; they address the psychosocial concerns that accompany hospitalization and other health care experiences. Child life specialists focus on the optimal development and well-being of infants, children, adolescents, and young adults while promoting coping skills and minimizing the adverse effects of hospitalization, health care encounters, and/or other potentially stressful experiences. In collaboration with the entire health care team and family, child life specialists provide interventions that include therapeutic play, expressive modalities, and psychological preparation to facilitate coping and normalization at times and under circumstances that might otherwise prove overwhelming for the child. Play and developmentally appropriate communication are used to (1) promote optimal development, (2) educate children and families about health conditions, (3) prepare children and partner with families for medical events or procedures, (4) plan and rehearse useful coping and pain-management strategies with patients and families, (5) help children work through feelings about past or impending experiences, and (6) partner with families to establish therapeutic relationships between patients, siblings, and caregivers. Child life specialists collaborate with the entire interdisciplinary team to promote coping and enhance the overall health care experience for patients and families.

Patients With Health-Related Social Needs More Likely to Report Poor Clinic Experiences.

Measuring patients’ care experience is necessary to understanding and improving health care quality and is a core component of patient-centered care. In this study, we test whether patient health care experiences differed between patients with and without health-related social needs, above and beyond demographic differences previously studied. This study relies on survey data from 2341 patients who visited 1 of 7 primary care clinics in Portland, Oregon, and surrounding communities during the latter half of 2018. Survey analysis reveal that patients with at least 1 health-related social need had greater odds of reporting staff not always answering questions, not getting all the care they need, not getting the information to manage care, not being treated with respect by their provider, and getting care being a hassle. The findings from this study suggest that patients with health-related social needs are not getting the holistic care they expect in their primary care clinics and find it a hassle to get care regardless of their demographic characteristics and insurance status. This study may help to inform how health care systems and clinics can best serve patients with health-related social needs.

Healthcare practitioner views and experiences of patients self-monitoring blood pressure: a vignette study.

BackgroundHome self-monitoring of blood pressure is widely used in primary care to assist in the diagnosis of hypertension, as well as to improve clinical outcomes and support adherence to medication. The National Institute for Health and Care Excellence (NICE) care pathways for hypertension recommend specific guidelines, although they lack detail on supporting patients to self-monitor.AimTo elicit primary care practitioners’ experiences of managing patients’ home blood pressure self-monitoring, across surgeries located in different socioeconomic areas.Design & settingA qualitative focus group study was conducted with a total of 21 primary care professionals.MethodParticipants were GPs and practice nurses (PNs), purposively recruited from surgeries in areas of low and high deprivation, according to the English indices of multiple deprivation. Six vignettes were developed featuring data from interviews with people who self-monitor and these were used in five focus groups. Results were thematically analysed.ResultsThemes derived in the thematic analysis largely reflected topics covered by the vignettes. These included: advice on purchase of a device; supporting home monitoring; mitigating patient anxiety experienced as a result of home monitoring; valuing patients’ data; and effect of socioeconomic factors.ConclusionThe work provides an account of methods used by primary care practitioners in the management of home blood pressure self-monitoring, where guidance may be lacking and primary care practitioners act on their own judgement. Findings complement recent policy documentation, which recognises the need to adopt new ways of working to empower patients (for example, additional support from healthcare assistants), but lacks detail on how this should be done.

Educational and Personal Opportunity Costs of Medical Student Preparation for the United States Medical Licensing Examination Step 1 Exam: A Single-Center Study.

PurposeTo assess the degree to which medical students choose to disengage from their regular preclinical curriculum and extracurricular activities in order to focus on United States Medical Licensing Examination (USMLE) Step 1 exam preparation, as well as learner-perceived effects of Step 1 preparation on their physical, social, and mental health.MethodOnline survey of medical students who have taken the USMLE Step 1 exam at a single large Midwestern academic medical center.ResultsThe response rate was 54%. Students often reported absenteeism from a variety of preclinical curricular activities, including lectures (44%) and didactics focusing on medical ethics (37%), clinical skills (28%), and encounters with actual and standardized patients (9%) in order to study for USMLE Step 1. Many students also forewent extracurricular opportunities including research (53%), elective patient care opportunities (45%), community service (39%), and healthcare advocacy experiences (38%) in order to study for USMLE Step 1. Majorities of students identified Step 1 preparation as a cause of burnout (79%) or significant anxiety or depression (61%), for which nearly a third sought mental healthcare; students also reported Step 1 preparation as a cause of engaging in dangerous behaviors such as illicit prescription stimulant use as well as driving or providing patient care while impaired by fatigue. In narrative comments, students frequently described Step 1 to be a barrier to their development into effective clinicians, the traditional medical school curriculum to be a barrier to performance on Step 1, or both.ConclusionsMedical students often prioritize Step 1 exam preparation over engaging with the standard preclinical curriculum, extracurricular opportunities, and activities to promote wellbeing. These findings have implications for the emphasis residency program directors place on single high-stakes standardized exams in the resident recruitment process.

Podoconiosis in Rwanda: Knowledge, attitudes and practices among health professionals and environmental officers.

BackgroundPodoconiosis is a neglected tropical disease commonly found in volcanic regions, where soil is rich in silica. It usually manifests as bilateral lower limb edema. The majority of people affected by podoconiosis are farmers who do not wear shoes. The condition was recently documented in all 30 districts in Rwanda but knowledge, attitudes and practices (KAP) of Rwandan health professionals and environmental officers towards podoconiosis are unknown.Methodology/FindingsThe objective of this study was to assess the knowledge, attitudes and practices (KAP) of Rwandan health providers and environmental officers towards podoconiosis in order to improve patient healthcare experiences and health outcomes, and to reduce stigma against affected individuals. To achieve this goal, we administered a KAP assessment to physicians (N = 13), nurses/midwives (N = 59), community health workers (N = 226), and environmental officers (N = 38) in the third highest podoconiosis prevalence district in Rwanda (Musanze).All 336 respondents had heard of podoconiosis, but 147 (44%) respondents correctly identified soil as the only direct cause of podoconiosis. The awareness of signs and symptoms and risk groups was lower than any other category (31.5% and 47.5%, respectively). The overall attitude toward podoconiosis was positive (86.1%), with CHWs least likely to harbor negative beliefs against podoconiosis patients. One particular area where most respondents (76%) expressed negative attitude was that they saw people with podoconiosis as a threat to their own health and their family’s health. Prescription of antibiotics and use of ointments/soap to manage wounds was low (5% and 32.2%, respectively), in part due to supply shortages at health facilities.ConclusionsThis study identified clear gaps in health provider knowledge and practices that affect patient care for those with podoconiosis. Improved access to essential medicines at health facilities and podoconiosis-focused training sessions for practicing health providers are necessary to minimize the burden and stigma of affected individuals.